Medical Intensive Care Unit Admissions for Syncope

To the Editor.— Silverstein et al recently published an important analysis of patients with syncope who were admitted to their medical intensive care unit (ICU) (1982;248:1185). We would like to raise some relevant points stimulated by their article. First, we appreciate the difficulty in diagnosing ventricular dysrhythmias as the true cause of syncope after the fact. Their criteria, using the recognition of couplets or frequent (>20/ min) ventricular premature contractions during the subsequent hospitalization of a patient, may be the best one can do, realizing that this will lead to both false-positive and false-negative results. False-positive results could be seen in an older patient with vasovagal syncope who, when monitored, later happened to have ventricular couplets. Fleg and Kennedy¹ studied a population of healthy subjects older than 60 years who had been carefully screened for the absence of heart disease (including normal treadmill test results). Twenty-four-hour Holter monitoring revealed